Euthanasia in the Netherlands

"Experts" in the fields of medical and bio-ethics agree that the issues of infanticide, euthanasia and assisted suicide will prove even more important and hotly debated in the new millennium than in the waning decades of the 20th century. With the release of the Canadian Senate Committee's report "Quality End of Life Care: The Right of Every Canadian" (subject of my next column) and with the imminent release by the Supreme Court of it's verdict in the Latimer case, a review of the situation in the Netherlands will be educational for Canadians, especially those of Dutch extraction.

In June of 1994 I accompanied my father, then aged 82 and in failing health, on a trip which was, in all likelihood, going to be his last. We went to the Netherlands to bid farewell to all his siblings. Watching the television news one evening with my uncle's family an item came on regarding a fifty-year-old divorcee. "Netty Boomsma" - the fictional name given to the woman by her psychiatrist, Dr. Boudewijn Chabot - had lost her second son, aged twenty, to cancer in May 1991. Her first son had died by suicide some years earlier, also at the age of twenty. In despair, "Netty" had asked Dr. Chabot to kill her and he had complied. She refused all treatment and none was forced on her. As a matter of fact, Dr. Boudewijn did not consider her depressed, at least not in the clinical sense. She was a woman who wanted to die and he was a doctor who had made himself available to the Dutch Voluntary Euthanasia Society for referrals. Since euthanasia, though commonly practiced in Holland, had not yet been legalized the psychiatrist was charged in her death. After being acquitted in the lower courts, the Supreme Court of the Netherlands had rendered a verdict that day finding the Doctor not guilty. This case, one of many over the last twenty years, moved the practice of euthanasia in Holland one step forward. The Dutch were now willing to accept euthanasia for mental anguish.

I closely watched the reaction of my aunt and uncle to this news. My uncle, though 27 years younger than my father, was raised in the same family. Dad is, and always has been, a devout Christian man. He would never approve of euthanasia even under difficult circumstances. As I said, I watched my relatives for some reaction. There was absolutely none. Their eyes were just as glazed over as if they had been watching a report of a minor traffic accident. Probably more so than if the accident had been in their neighbourhood. Finally, I asked them, "Doesn't this bother you?" They gave a ho-hum answer to the effect that this would never happen to them so they weren't concerned. I commented that there were people who had survived the holocaust, losing every family member, every friend and who had gone on to live basically happy, though perhaps somewhat more sober, lives. Didn't they think the psychiatrist should have treated her for depression? Well they replied, this was, obviously, what she wanted.

Some twenty years ago, people in the Netherlands, well-intentioned physicians among them, began a process that has made physician-assisted suicide and euthanasia common practice there today. Until this year criminal law ostensibly provided punishment for euthanasia and assisted suicide, but, in reality, these practices went basically unpunished. In a series of cases over the last twenty years, the Dutch Courts have ruled that euthanasia is permitted when a doctor faces an irresolvable conflict between the law, which made euthanasia illegal, and his responsibility to help a patient whose "irremediable suffering makes euthanasia necessary".

The Dutch courts and the Royal Dutch Medical Association KNMG established guidelines for physicians to follow in selecting patients for either assisted suicide or euthanasia: (1) voluntariness - patients request must be freely made, well-considered and persistent (2) unbearable suffering - patients suffering cannot be relieved by any other means, and (3) consultation - the attending physicians should consult with a colleague. If these guidelines were followed physicians would not be prosecuted. According to Dr. Herbert Hendin, American author of, "Seduced by Death", even these broad guidelines have been largely ignored, to the point were the doctors who help set euthanasia guidelines will privately admit that euthanasia in the Netherlands is basically out of control.

Before 1991 it was difficult to obtain facts about the incidence of euthanasia in Holland, because the KNMG had chosen a very narrow definition of the word. The Dutch officially define euthanasia as the ending of the life of one person by another at the first person's request. If life is ended without request, as it often is, it is not considered to be euthanasia and therefore official statistics have always been lower than actual numbers. For example, Dutch doctors, for obvious reasons, prefer not to use the term "involuntary euthanasia" but call it the more sanitized "termination of the patient without explicit request". Dr. John Keown, an English legal scholar, has commented on this redefinition, "By narrowly defining euthanasia as referring only to "active voluntary euthanasia" rather than to all cases in which death is brought about on purpose as part of the medical care given to the patient, the Dutch minimize the frequency with which death is "intentionally accelerated by a doctor."

In 1991, in an effort to come to grips with the actual medical practice of euthanasia and assisted suicide, the Dutch Government established a government commission, headed by Professor Jan Remmelink to study the problem. The Remmelink Report opened the eyes of both the people of the Netherlands and the world to the extent of the practice of euthanasia in Holland. Remmelink found that 49,000 of the 130,000 deaths in the Netherlands each year were not natural but involved a "medical decision at the end of life" or MDEL. 95% of these MDEL cases involve, in equal numbers, either withholding treatment/discontinuing life support or the alleviation of pain and symptoms through medication that might hasten death. This latter (alleviating pain and symptoms) category accounted for approx. 20,000 deaths that had been hastened by a physicians decision. Actual euthanasia, using the official Dutch definition, occurred in 2,300 cases or 2% of all Dutch deaths. Dutch physicians helped 400 patients who requested suicide, for either mental illness or discomfort, to kill themselves in 1990. The alarming statistics of the Remmelink Report indicate that in thousands of cases decisions that might or were intended to end a fully competent patient's life were made without consulting the patient.

Over 50% of Dutch physicians admitted to practicing euthanasia, most often on cancer patients. Only 60% kept written records of their euthanasia practice and only 29% filled out death certificates honestly in euthanasia cases.

In 1996 a second report on euthanasia in Holland (for 1995) was published. In the interim the number of cases where a doctor had made a decision with the intention to hasten death without the patients express request had risen from 15% to almost 20% of the total annual mortality rate of the Netherlands. At the same time, the number of cases of euthanasia, using the narrow Dutch definition, rose from 2,300 to over 3000, a 30% increase in just 5 years.

Dutch physicians, through the KNMG have long wanted these killings codified in law in order to protect themselves from prosecution. The Christian Democrat Alliance CDA (formerly Anti-Revolutionary party) opposed this, believing that so long as it was not legalized there was always a possibility of reversing the course of it's increasing normalization. Over the years, however, they did very little other than call for better reporting and review in order to prevent abuse, a plan that obviously did not work. In the Spring of 1998, three members of the Dutch Parliament introduced a Bill to change the Criminal Code and the Act on Burials in order to legalize (subject to certain conditions) euthanasia and assisted suicide. This Bill, which is expected to pass this summer, would normalize in law, actions that are already common. The Bill basically codifies the present KNMG guidelines with one rather important and startling addition. Section A(6) of the Bill States,

"If the patient is aged between 12 - 18, his or her legal representatives are involved in the decision making. If one of them cannot agree with the termination of life, the patients request is not granted, unless he keeps requesting and his termination of life is well-considered and the emergency situation does not permit delaying the termination of life according to the doctor's judgement."

Canadian professor of law and medicine at McGill University, Margaret Somerville, has said "ůstrict guidelines or no, legalized euthanasia has less to do with "unbearable suffering" than with institutionalizing murder in the medical profession." This is precisely what has happened in the Netherlands.

In 30 years Holland has moved from assisted suicide to euthanasia, from euthanasia of people who are terminally ill to euthanasia of those who are chronically ill, from euthanasia for physical illness to euthanasia for mental illness, from euthanasia for mental illness to euthanasia for psychological distress or mental suffering, and from voluntary euthanasia to involuntary euthanasia or as the Dutch prefer to call it "termination of the patient without explicit request".

It is now considered a form of discrimination against the chronically ill to deny them assisted death because they will be forced to suffer longer than those who are terminally ill and it is considered bias to force endurance of psychological pain when it is not associated with physical illness. The next step, non-voluntary euthanasia, is then justified by appealing to our social duty to care for patients who are not competent to choose for themselves.

A little over a hundred years ago the Dutch spawned a political party in direct response to the Godless cry of the French Revolution, "No God! No Master!" The Anti-Revolutionary Party proclaimed and worked for Christianity in all areas of life. Just one century later the French Revolution and its cry for absolute human autonomy has triumphed in the Netherlands.